CHENNAI: Meant to come to the rescue of hapless patients, hospitals have instead turned into a breeding ground for deadly infections. The situation is alarming, to say the least. There are numerous instances where patients admitted to hospital for surgery or any other disease, acquired hospital-associated infections such as central line-associated bloodstream infections, catheter-associated urinary tract infections and ventilator-associated pneumonia. These are exceedingly critical medical conditions to handle for the simple reason that the bacteria responsible are resistant to even the strongest antibiotics available. Literally helpless against the onslaught of these superbugs, the hospital staff has no choice other than administering a very high dose of antibiotic or one antibiotic after another in the hope that at least one of them might work. This blatant hit-and-trial approach, which most hospitals are constrained to adopt despite the advancements in modern medicine, may or may not work. If at all it does, the patient should consider himself extremely lucky to be alive.
Patients in hospitals have low immunity and are often too weak to fight off germs, thereby making the entire treatment procedure complicated. On account of high levels of exposure to antibiotics and their prolonged misuse, these bacteria develop resistance a natural survival strategy. These resistant bacteria, often termed superbugs, are responsible for more dangerous infections that call for advanced antibiotics.
According to the US-based Centres for Disease Control and Prevention (CDC), 2 million people in America are infected by hospital-acquired (nosocomial) infections annually, resulting in 20,000 deaths. There is no reliable data available for India, although the Indian Council of Medical Research (ICMR) has undertaken studies to pinpoint the causes of anti-microbial resistance (AMR).
While one section of experts claims that hospital-acquired infections accounted for 50 per cent of all infections around five years ago, others claim that the average incidence ranges from 10 to 30 per cent. Whatever the case may be, the situation is grave and demands immediate attention.
One report, ‘Situation analysis: Antibiotic use and resistance in India,’ based on a study conducted by the Global Antibiotic Resistance Partnership (GARP) and the Centre for Disease Dynamics, Economics and Policy (CDDEP), pointed out that in ICUs in India, the prevalence of vancomycin-resistant enterococcus, a deadly nosocomial infection, was five times higher than the rest of the world.
The problem of AMR first came to public notice in India in 2010 with a report in Lancet, one of the world’s leading medical journals, claiming the emergence of a new antibiotic resistance phenomenon in the form of the enzyme NDM-1 (New Delhi metallo-B lactamase-1) in 2009. The report, prepared by British researchers in association with a Chennai-based microbiologist, claimed that the enzyme was produced by a resistant gene which was found in a Swedish patient who had undergone surgery in New Delhi. The gene could be transferred between the Klebsiella pneumoniae and other gram negative bacterial species, thus making them resistant to all known antibiotics, even carbapenem.
The government must understand the gravity of the situation and draft a policy for an antibiotic stewardship programme. It should also initiate a national survey on the prevalence of AMR. Some NGOs are working towards collection of data and creating awareness, but without government support, these efforts will not be enough. India needs to focus on continuous medical education updates for practising doctors. It should also include the ramifications of AMR in the medical curriculum and ensure infection-control protocols in hospitals. With an appropriate protocol in place, the right antibiotic can be administered at the right time, thus cutting down the presumptive treatment period.
Although hospital-acquired infections are universal, they are more common in India owing to poor hospital hygiene practices, absence of infection control protocols, lack of awareness among the nursing staff and want of guidelines from the government to update doctors’ knowledge on the latest breakpoints and susceptibility patterns. Government hospitals and small clinics are even more vulnerable. The ultimate answer lies in the collective effort by the government, medical fraternity, NGOs and pharmaceutical companies.
Developing more advanced drugs to fight AMR is an option, but since bacteria are smarter and faster than the pace of research, a translational medicine approach is the only solution left to nip the evil in the bud. Are we ready for the challenge?
(The writer is a scientist working on anti-microbial resistance and heading the Venus Medicine Research Centre, Baddi)